<!-- INCLUDE header.tpl -->
    	<div style="width:25%; float:left;">
            <div style="margin-left:auto; margin-right:auto;">
            	<!-- INCLUDE sidebar-{CURRENT_PAGE}.tpl -->
            </div>
        </div>
    	<div style="width:75%; float:right;">
            <div class="main-box">
            	<h4 class="rounded-top rounded-bottom">{L_25_0010}&nbsp;&gt;&gt;&nbsp;{L_045}&nbsp;&gt;&gt;&nbsp;{L_511}</h4>
				<form name="errorlog" action="" method="post">
<!-- IF ERROR ne '' -->
					<div class="error-box"><b>{ERROR}</b></div>
<!-- ENDIF -->
                    <table width="98%" celpadding="0" cellspacing="0" class="blank">
                    <tr>
                        <td width="204">{L_302} *</td>
                        <td><input type="text" name="name" size="40" maxlength="255" value="{REALNAME}"></td>
                        <td><b>{L_448}</b></td>
                    </tr>
                    <tr>
                        <td>{L_003}</td>
                        <td>{USERNAME}</td>
                        <td rowspan="15" width="33%" valign="top">
                            {USERGROUPS}
                        </td>
                    </tr>
                    <tr class="bg">
                        <td>&nbsp;</td>
                        <td><small>{L_243}</small></td>
                    </tr>
                    <tr class="bg">
                        <td>{L_004} *</td>
                        <td><input type="password" name="password" size="20" maxlength="20"></td>
                    </tr>
                    <tr class="bg">
                        <td>{L_004} *</td>
                        <td><input type="password" name="repeat_password" size="20" maxlength="20"></td>
                    </tr>
                    <tr>
                        <td>{L_303} *</td>
                        <td><input type="text" name="email" size="50" maxlength="50" value="{EMAIL}"></td>
                    </tr>
                    <tr>
                        <td>{L_252}{REQUIRED(0)}</td>
                        <td><input type="text" name="birthdate" size="10" maxlength="10" value="{DOB}"></td>
                    </tr>
                    <tr>
                        <td>{L_009}{REQUIRED(1)}</td>
                        <td><input type="text" name="address" size="40" maxlength="255" value="{ADDRESS}"></td>
                    </tr>
                    <tr>
                        <td>{L_010}{REQUIRED(2)}</td>
                        <td><input type="text" name="city" size="40" maxlength="255" value="{CITY}"></td>
                    </tr>
                    <tr>
                        <td>{L_011}{REQUIRED(3)}</td>
                        <td><input type="text" name="prov" size="40" maxlength="255" value="{PROV}"></td>
                    </tr>
                    <tr>
                        <td>{L_012}{REQUIRED(5)}</td>
                        <td><input type="text" name="zip" size="15" maxlength="15" value="{ZIP}"></td>
                    </tr>
                    <tr>
                        <td>{L_014}{REQUIRED(4)}</td>
                        <td>
                            <select name="country">
                                <option value=""></option>
                                {COUNTRY_LIST}
                            </select>
                        </td>
                    </tr>
                    <tr>
                        <td>{L_013}{REQUIRED(6)}</td>
                        <td><input type="text" name="phone" size="40" maxlength="40" value="{PHONE}"></td>
                    </tr>
                    <tr>
                        <td>{L_763}</td>
                        <td><input type="text" name="balance" size="40" maxlength="10" value="{BALANCE}"></td>
                    </tr>
                    <tr>
                        <td>&nbsp;</td>
                        <td><a href="userfeedback.php?id={ID}">{L_208}</a></td>
                    </tr>
                    </table>
                    <input type="hidden" name="id" value="{ID}">
                    <input type="hidden" name="offset" value="{OFFSET}">
                    <input type="hidden" name="action" value="update">
                    <input type="hidden" name="idhidden" value="{ID}">
                    <input type="hidden" name="mode" value="{MODE}">
                    <input type="hidden" name="csrftoken" value="{_CSRFTOKEN}">
                    <input type="submit" name="act" class="centre" value="{L_071}">
				</form>
            </div>
        </div>
<!-- INCLUDE footer.tpl -->